Healthcare Provider Details

I. General information

NPI: 1053067934
Provider Name (Legal Business Name): KATHY RUMMAGE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/01/2022
Last Update Date: 03/01/2022
Certification Date: 03/01/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2611 LIBERTY HILL RD
CAMDEN SC
29020-1871
US

IV. Provider business mailing address

105 DOGWOOD CIR
CHERAW SC
29520-2907
US

V. Phone/Fax

Practice location:
  • Phone: 803-432-5323
  • Fax:
Mailing address:
  • Phone: 843-337-6345
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number101469
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: